Dysentery Outbreak Baffles Cincinnati Officials

An epidemic of an infectious dysentery disease has swept this city in recent months, afflicting mostly young children in diapers and their caregivers.

The city health department has tracked more than 2,000 cases of shigellosis, which causes stomach cramps, fever and diarrhea. That tally--mounting daily--makes the outbreak the second-largest shigellosis epidemic recorded by the federal Centers for Disease Control and Prevention in Atlanta.

Though new infections have slowed since summer, the Cincinnati Health Department has had to bring in additional nurses to handle the epidemic. And health officials still have not determined why shigellosis--which is caused by bacteria in fecal matter--took root here with such a vengeance.

“No one really seems to know why,” said Dr. Lawrence Holditch, the health department’s top primary-care physician. “It may just have been our turn.”

The largest shigellosis outbreak reported to the CDC involved more than 7,000 cases in North Carolina in 1987. Far more typical are isolated clusters of infection involving at most a few dozen patients. While the Cincinnati epidemic involves person-to-person transmission, shigellosis also can be spread through contaminated food, for instance, if a restaurant worker harboring the bacteria fails to wash her hands thoroughly.

The disease is almost never fatal, and just a few cases in Cincinnati so far have required hospitalization. Antibiotics generally take care of the bug, and even without medication most symptoms clear up within a week. Still, shigellosis has proved a major aggravation for thousands of Cincinnati parents.

To prevent the disease from spreading, health officials require infected children to stay out of school or day care as long as 10 days. Working parents unable to take time off from their jobs have been frantic to find child care for such lengthy stretches. Some have taken to enrolling their sick kids in different day care centers without letting on that they’re infectious.

“It’s been a big problem,” Holditch said. “People are somewhat desperate.”

Teachers are desperate, too--to keep the shigellosis bug at bay.

At the YWCA Early Childhood Program, director Karyn Cotton has banned the water table, where kids loved to splash and pour. Health officials say it’s simply too dangerous these days--the bacteria is too easily transmitted when so many hands are so close together.

Another casualty of the epidemic is Play-doh. It’s nearly impossible to disinfect.

On the positive side, children all over Cincinnati are learning a great deal about personal hygiene.

The public schools brought in a costumed character--Henry the Hand--to teach young kids a song about proper hand washing, which can prevent transmission of the disease. At the day care center on the University of Cincinnati campus, director Marty Frazier said the toddlers have become pros with soap and water. “We always had the children wash their hands constantly,” Frazier said. “Now, we do it even more.”

Despite such measures, the outbreak has proved hard to halt. So far this fall, 10 elementary schools have reported flare-ups, with a few kids in each school coming down with shigellosis. And at the city health department, the nurse who handles shigellosis cases is just as busy as the nurse assigned to deal with anthrax scares.

“We think we have it nailed, and then a few more cases pop up,” sighed Richard Ward, safety coordinator for Cincinnati public schools.

Last week, Cincinnati mother Elaine Ward found “an icky-looking test kit” in her daughter’s folder after kindergarten. Sure enough, one of the kids in the class had come down with shigellosis--and every student was required to bring in a stool sample on a cotton swab before administrators would let them return to the building. The next morning, the kindergarten teacher was at the door collecting sealed plastic bags of swabs.

“I’ve been through head lice,” Ward recalls her saying, “but this is a first.”